CC Trauma 1 Final Exam

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CC Trauma 1 Final Exam
2014-07-12 12:35:22

CC Trauma 1 Final
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  1. Mechanisms of Injury (MOI)
    used as a triage marker
  2. Blunt trauma/injury
    • no penetration of skin
    • force or speed is significant
    • accel or decel forces
    • external AND internal injuries common
  3. Blunt trauma:
    Shearing forces
    A= INcrease in speed of moving object, person still

    D= decrease in speed of moving object, victim is moving

    S= tearing of tissues
  4. effects of blunt trauma to abd
    • inc abd pressure ->
    • can lacerate liver, spleen, rupture stomach, bruise duodenum, and damage kidneys
  5. Blunt trauma:

    direct impact causes the greatest injury in most blunt traumas
  6. Penetrating trauma/injury
    external wound NOT reflective of internal wound
  7. stab wound-abd
    this can damage solid or hollow organs and cx massive bld loss

    hollow organ penetration leads to sepsis

    DO NOT remove a stab wound, this is only done in OR
  8. motor vehicle Crashes are no longer called Accidents b/c the are preventable
  9. formula for Force of car crash
    • speed, velocity, and mass are important
    • Primary thing affecting injuries are speed and weight

    Force = Mass x Acceleration

    Ex: 130lbs x 60mph = 7800 lbs of force
  10. car trauma and the elderly
    • 70-79 yr 2x more likely to die
    • >80 yr 5x
    • age related changes inc risk as well
  11. 300% increase risk of injury when ejected from vehicle
  12. top 3 areas of fatal injuries
    • 1. head injury
    • 2. chest/thorax
    • 3. abd
  13. Trauma deaths:
    Trimodal distribution %'s

    1st peak
    2nd peak
    3rd peak
    1= 50% of deaths occur w/n minutes (spinal, aortic rupture)

    2= 30% occur w/n minutes to hours (brain bld)

    3= 20% occur w/n days to weeks (sepsis, MODS)
  14. Goal of trauma centers
    • dec time to definitive care
    • inc expertise of care (specialty surgeons)
  15. Level 1 of 4 trauma center
    level 1 - regional resource center

    • req's:
    • neurosurgeon 24/7
    • CP bypass capability
    • Rehab, research, prevention programs
  16. EMS phase of trauma care
    goal = ID of injuries. stabiliztion, transport

    victim may need to be extricated which inc rick of complications
  17. ED phase of trauma care
    • rapid assessment
    • verification of injuries
    • resuscitation
    • definitive care (OR or something to dx extent of injuries)
  18. Rapid assessment of BP:
    60-70-80 rule
    if you can feel a pulse at these spots, then the BP is at least this amount:

    • Carotid - 60 mmHg
    • Femoral - 70 mmHg
    • Radial - 80 mmHg
  19. Revised Trauma Score (RTS)
    estimates acuity and severity of pt's physiological response to injury

    • Range 0-12
    • SBP 0-4
    • RR 0-4
    • GCS 0-4

    Trauma center rec'd if <11
  20. who does the primary and secondary survey's of a victim?
    both the EMS and the ED
  21. Primary survey
    goal is ID and Tx LIFE-THREATENING injures (ensure survival)

    ABC's are priority of care
  22. ABC's of primary survey
    • A= airway and spine stabiliztion
    •  =use jaw thrust instead of head tilt is neck injury suspected

    B= breathing

    c= circulation, pulse?, rapid BP assess, insert 2 large bore IV's (14 or 16g)

    D= disability, neuro assess

    E= Expose pt, remove clothes to look at all areas of body for injuries
  23. intraosseous vascular access
    • can be used for 24 hrs
    • rapid absorption
  24. AVPU mnemonic for Disability
    quick method of classifying neuro assessment

    • Alert
    • response to Verbal stimuli
    • response to Painful stimuli
    • Unresponsive
  25. Secondary survey
    goal is ID of ALL injuries (only after all lifesaving measures have been taken)

    continue with alphabet F G H I
  26. FGHI with secondary assess
    • Fahrenheit - keep pt warm
    • Get VS and add gadgets (NG, OG, Foley, etc.)
    • Head-to-toe exam and Hx
    • Inspect posterior surfaces
    •  -log rolled and full SPINAL imobilization

    REASSESS ABC's after care
  27. mass casualty triage

    >25 people

    Goal is rapid categorization of injuries

    Priority is Tx and transport victims with greatest need AND best chances of survival w/ least expenditure of equipment and staff
  28. tag system of mass triage
    • black - dead or dying
    • red- serious injury, immediate transport
    • yellow - less serious, significant MOI, delayed transport up to 1hr
    • green - walking wounded, delay care up to 3 hrs
  29. S.T.A.R.T system

    3 key areas
    simple triage and rapid assessment

    • RPM
    • Respirations (rate and airway)
    • Pulse (radial, femoral, and corotid)
    • Mental Status (follow commands, alert, responsive)
  30. 3 Tx's during triage
    unemotional, quick Tx

    • open airway/insert airway
    • stop blding
    • elevate limbs (inc venous return)